When to Escalate
Why Infection Can Be Harder to Detect
Diabetes increases both the likelihood of infection and the chance that a minor problem will become serious before it is recognized.
Diabetes increases both the likelihood of infection and the chance that a minor problem will become serious before it is recognized. Persistent hyperglycaemia impairs neutrophil function and cytokine signalling, weakening early immune responses to bacterial and viral pathogens. Vascular disease can limit oxygen delivery, nutrient delivery, and antibiotic penetration into infected tissue. Neuropathy removes pain as an alarm signal, especially in the feet. A person may therefore have substantial tissue infection with less pain, erythema, or fever than expected. Absence of fever does not rule out infection in an older adult, a person with chronic kidney disease, or a person with poorly controlled diabetes. Acute infection also raises counter-regulatory hormones such as cortisol and catecholamines. The result is rising blood glucose and increased insulin resistance. Unexplained hyperglycaemia in a person whose readings are usually stable should prompt assessment for infection, medication changes, missed insulin, dietary changes, and other causes of physiologic stress.